COVID-19 Accelerated Cognitive Decline in Elderly Patients with Pre-Existing Dementia Followed up in an Outpatient Memory Care Facility
Abstract
1. Introduction
2. Methods
2.1. Patients
2.2. Dementia Diagnosis, Cognitive Function, and ADL Assessment of Patients
2.3. Statistical Methods
3. Results
3.1. Predictors of COVID-19 and Cognitive Decline
3.2. Effect of COVID-19 on the Yearly Change in MMSE Score and ADL Indexes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All | Without COVID-19 | With COVID-19 | p | |
---|---|---|---|---|
Patients (n) | 111 | 80 | 31 | - |
Baseline variables | ||||
Age (years) | 82 ± 5 | 82 ± 5 | 83 ± 5 | 0.315 |
Male sex (n (%)) | 35 (32) | 24 (30) | 11 (36) | 0.651 |
Hypertension (n (%)) | 66 (60) | 44 (55) | 22 (71) | 0.138 |
Diabetes (n (%)) | 27 (24) | 15 (19) | 12 (39) | 0.047 |
Dyslipidemia (n (%)) | 41 (37) | 30 (38) | 11 (36) | 1.000 |
Cerebrovascular disease (n (%)) | 11 (9.9) | 8 (10) | 3 (9.7) | 1.000 |
Cardiovascular disease (n (%)) | 37 (33) | 26 (33) | 11 (36) | 0.824 |
Chronic kidney disease (n (%)) | 10 (9.0) | 7 (8.8) | 3 (9.7) | 1.000 |
Parkinson’s disease (n (%)) | 7 (6.3) | 7 (8.8) | 0 | 0.187 |
Self-sufficient (n (%)) | 26 (23) | 22 (28) | 4 (13) | 0.136 |
Institutionalized (n (%)) | 7 (6.3) | 2 (2.5) | 5 (16) | 0.018 |
Dementia type (n (%)): | 0.729 | |||
| 28 (25) | 21 (26) | 7 (23) | |
| 25 (23) | 19 (24) | 6 (19) | |
| 37 (33) | 24 (30) | 13 (42) | |
| 21 (19) | 16 (20) | 5 (16) | |
BADL index | 5.0 [3.0, 5.5] | 5.0 [3, 6] | 3.0 [2, 4] | 0.006 |
IADL index | 2.0 [1.0, 4.0] | 3.0 [1, 4] | 1.0 [0, 3] | 0.020 |
MMSE score | 19.1 ± 5.0 | 19.8 ± 4.3 | 17.5 ± 6.3 | 0.027 |
Total drugs number | 4.0 [2.0, 6.0] | 3.5 [2.0, 6.0] | 5.0 [3.0, 6.0] | 0.107 |
Memantine (n (%)) | 5 (4.5) | 4 (5.0) | 1 (3.2) | 1.000 |
Anticholinergic drug (n (%)) | 17 (15) | 11 (14) | 6 (19) | 0.558 |
Antipsychotic drug (n (%)) | 22 (20) | 15 (19) | 7 (23) | 0.791 |
Antidepressant drug (n (%)) | 23 (21) | 16 (20) | 7 (23) | 0.797 |
Benzodiazepines (n (%)) | 21 (19) | 16 (20) | 5 (16) | 0.790 |
Follow-up variables | ||||
Follow-up time (years) | 1.1 [0.7–1.7] | 1.2 [0.8, 1.9] | 0.9 [0.6, 1.2] | 0.013 |
Change in MMSE score | −3.0 [−6.8, −1.4] | −2.7 [−5.8, −1.0] | −6.0 [−10, −3.2] | 0.002 |
Significant cognitive decline (n (%)) | 44 (40) | 25 (31) | 19 (61) | 0.005 |
Change in BADL index | −1.0 [−2.0, 0.0] | −1.0 [−2.0, 0.0] | −1.0 [−2.0, 0.0] | 0.848 |
Change in IADL index | −1.0 [−2.5, 0.0] | −1.0 [−3.0, 0.0] | −1.0 [−2.0, 0.0] | 0.235 |
Hospitalization for any cause (n (%)) | 6 (5.4) | 0 | 6 (19) | <0.001 |
New institutionalization (n (%)) | 30 (27) | 16 (20) | 14 (45) | 0.016 |
Without Cognitive Decline | With Cognitive Decline | p | |
---|---|---|---|
Patients (n) | 67 | 44 | - |
Baseline variables | |||
Age (years) | 82 ± 5 | 82 ± 6 | 0.734 |
Male sex (n (%)) | 19 (28) | 16 (36) | 0.409 |
Hypertension (n (%)) | 38 (57) | 28 (64) | 0.555 |
Diabetes (n (%)) | 14 (21) | 13 (30) | 0.367 |
Dyslipidemia (n (%)) | 26 (39) | 15 (34) | 0.690 |
Cerebrovascular disease (n (%)) | 4 (6.0) | 7 (16) | 0.109 |
Cardiovascular disease (n (%)) | 23 (34) | 14 (32) | 0.839 |
Chronic kidney disease (n (%)) | 5 (7.5) | 5 (11) | 0.514 |
Parkinson’s disease (n (%)) | 4 (6.0) | 3 (6.8) | 1.000 |
Self-sufficient (n (%)) | 21 (31) | 5 (11) | 0.021 |
Institutionalized (n (%)) | 3 (4.5) | 4 (9.1) | 0.432 |
Dementia type (n (%)) | 0.808 | ||
| 18 (27) | 10 (23) | |
| 13 (19) | 12 (28) | |
| 23 (34) | 14 (32) | |
| 13 (19) | 8 (18) | |
MMSE score | 18.8 ± 4.4 | 19.6 ± 5.7 | 0.390 |
BADL index | 5.0 [3.0, 5.5] | 4.5 [3.0, 5.25] | 0.963 |
IADL index | 2.0 [1.0, 5.0] | 2.0 [1.0, 4.0] | 0.552 |
Total drugs number (n) | 4.0 [2.0, 6.0] | 4.0 [2.0, 6.0] | 0.340 |
Memantine (n (%)) | 1 (1.5) | 4 (9.1) | 0.079 |
Anticholinergic drug (n (%)) | 10 (15) | 7 (16) | 1.000 |
Antipsychotic drug (n (%)) | 14 (21) | 8 (18) | 0.811 |
Antidepressant drug (n (%)) | 14 (21) | 9 (21) | 1.000 |
Benzodiazepine drug (n (%)) | 14 (21) | 7 (16) | 0.623 |
Follow-up variables | |||
COVID-19 (n (%)) | 12 (18) | 19 (43) | 0.005 |
Follow-up time (years) | 1.1 [0.8, 1.8] | 1.1 [0.7, 1.5] | 0.602 |
Change in MMSE score | −2.0 [−3.0, 0.0] | −8.2 [−10.1, −6.0] | <0.001 |
Change in BADL index | 0.0 [−1.0, 0.0] | −1.0 [−2.25, 0.0] | 0.001 |
Change in IADL index | −1.0 [−2.0, 0.0] | −1.0 [−3.0, −1.0] | 0.192 |
Hospitalization for any cause (n (%)) | 1 (1.5) | 5 (11) | 0.035 |
New institutionalization (n (%)) | 14 (21) | 16 (36) | 0.084 |
COVID-19 | Cognitive Decline | |||
---|---|---|---|---|
Variable | HR (95% CI) | p | HR (95% CI) | p |
Age (every 10 years) | 1.43 (0.73, 2.80) | 0.293 | 0.98 (0.56–1.71) | 0.936 |
Male sex (yes/no) | 1.39 (0.66, 2.91) | 0.382 | 1.62 (0.86, 3.02) | 0.133 |
Hypertension (yes/no) | 2.12 (0.97, 4.63) | 0.059 | 1.77 (0.94, 3.33) | 0.078 |
Diabetes (yes/no) | 2.31 (1.11, 4.78) | 0.025 | 1.38 (0.71, 2.67) | 0.344 |
Dyslipidemia (yes/no) | 0.99 (0.47, 2.09) | 0.988 | 1.07 (0.56, 2.03) | 0.841 |
Cerebrovascular disease (yes/no) | 1.00 (0.30, 3.30) | 0.994 | 2.28 (0.99, 5.25) | 0.053 |
Cardiovascular disease (yes/no) | 1.29 (0.62, 2.69) | 0.503 | 1.17 (0.61, 2.23) | 0.635 |
Chronic kidney disease (yes/no) | 1.06 (032, 3.52) | 0.919 | 1.62 (0.63, 4.17) | 0.319 |
Parkinson’s disease (yes/no) | - | - | 0.98 (0.30, 3.22) | 0.973 |
Self-sufficient (yes/no) | 0.46 (0.16, 1.32) | 0.148 | 0.42 (0.17, 1.08) | 0.073 |
Institutionalized (yes/no) | 2.86 (1.10, 7.48) | 0.032 | 1.69 (0.60, 4.79) | 0.320 |
Dementia type (yes/no): | ||||
| 1.00 | - | 1.00 | - |
| 0.99 (0.33, 2.93) | 0.980 | 1.52 (0.65, 3.54) | 0.331 |
| 1.58 (0.63, 3.97) | 0.329 | 1.33 (0.58, 3.02) | 0.498 |
| 0.84 (0.26, 2.64) | 0.759 | 0.68 (0.26, 1.80) | 0.434 |
BADL (every 1 point) | 0.66 (0.51, 0.85) | 0.001 | 0.79 (0.64, 0.99) | 0.039 |
IADL (every 1 point) | 0.80 (0.67, 0.96) | 0.014 | 0.86 (0.75, 0.98) | 0.026 |
MMSE score (every 1 point) | 0.92 (0.86, 0.99) | 0.024 | 0.98 (0.92, 1.04) | 0.548 |
New institutionalization (yes/no) | - | - | 1.71 (0.91, 3.20) | 0.096 |
Drug numbers (every 1 drug) | 1.15 (1.00, 1.32) | 0.054 | 1.13 (1.01, 1.27) | 0.038 |
Memantine (yes/no) | 0.83 (0.11, 6.12) | 0.853 | 4.13 (1.42, 12.0) | 0.009 |
Anticholinergic drug (yes/no) | 1.63 (0.66, 4.01) | 0.290 | 1.83 (0.79, 4.21) | 0.157 |
Antipsychotic drug (yes/no) | 1.43 (0.61, 3.34) | 0.412 | 1.48 (0.67, 3.23) | 0.330 |
Antidepressant drug (yes/no) | 1.25 (0.54, 2.92) | 0.604 | 1.30 (0.62, 2.76) | 0.487 |
Anxiolytic drug (yes/no) | 0.78 (0.30, 2.04) | 0.616 | 0.67 (0.28, 1.60) | 0.368 |
COVID-19 (yes/no) | - | - | 3.94 (2.09, 7.43) | <0.001 |
Hospitalization for any cause (yes/no) | - | - | 4.10 (1.59, 10.6) | 0.003 |
Dependent Variable | |||
---|---|---|---|
MMSE Score | Basic ADL | Instrumental ADL | |
Independent Variable | Estimate (95% CI) | Estimate (95% CI) | Estimate (95% CI) |
A | |||
COVID-19 (yes/no) | −3.1 (−5.4, −0.9) ** | −0.9 (−1.5, −0.2) ** | −1.0 (−1.9, −0.2) * |
Follow-up (year) | −1.7 (−2.3, −1.1) *** | −0.5 (−0.7, −0.4) *** | −0.8 (−1.0, −0.6) *** |
COVID x Follow-up | −1.6 (−3.0, −0.2) * | −0.2 (−0.6, 0.2) | −0.1 (−0.6, 0.4) |
B | |||
COVID-19 (yes/no) | −3.4 (−5.7, −1.0) ** | −0.8 (−1.5, −0.1) * | −1.0 (−1.9, −0.05) * |
Follow-up (year) | −1.7 (−2.2, −1.1) *** | −0.5 (−0.7, −0.4) *** | −0.8 (−1.0, −0.6) *** |
COVID x Follow-up | −1.5 (−2.9, −0.06) * | −0.2 (−0.6, 0.2) | −0.1 (−0.6, 0.4) |
C | |||
COVID-19 (yes/no) | −1.6 (−3.9, 0.7) | −0.6 (−1.3, 0.1) | −0.7 (−1.7, 0.3) |
Follow-up (year) | −1.7 (−2.2, −1.1) *** | −0.5 (−0.7, −0.4) *** | −0.8 (−1.0, −0.6) *** |
COVID x Follow-up | −1.5 (−2.9, −0.08) * | −0.2 (−0.6, 0.2) | −0.1 (−0.6, 0.4) |
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Merla, L.; Montesi, M.C.; Ticali, J.; Bais, B.; Cavarape, A.; Colussi, G. COVID-19 Accelerated Cognitive Decline in Elderly Patients with Pre-Existing Dementia Followed up in an Outpatient Memory Care Facility. J. Clin. Med. 2023, 12, 1845. https://doi.org/10.3390/jcm12051845
Merla L, Montesi MC, Ticali J, Bais B, Cavarape A, Colussi G. COVID-19 Accelerated Cognitive Decline in Elderly Patients with Pre-Existing Dementia Followed up in an Outpatient Memory Care Facility. Journal of Clinical Medicine. 2023; 12(5):1845. https://doi.org/10.3390/jcm12051845
Chicago/Turabian StyleMerla, Lucia, Maria Cristina Montesi, Jessica Ticali, Bruno Bais, Alessandro Cavarape, and GianLuca Colussi. 2023. "COVID-19 Accelerated Cognitive Decline in Elderly Patients with Pre-Existing Dementia Followed up in an Outpatient Memory Care Facility" Journal of Clinical Medicine 12, no. 5: 1845. https://doi.org/10.3390/jcm12051845
APA StyleMerla, L., Montesi, M. C., Ticali, J., Bais, B., Cavarape, A., & Colussi, G. (2023). COVID-19 Accelerated Cognitive Decline in Elderly Patients with Pre-Existing Dementia Followed up in an Outpatient Memory Care Facility. Journal of Clinical Medicine, 12(5), 1845. https://doi.org/10.3390/jcm12051845